| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
4,628 |
4,580 |
$636K |
| D1120 |
Prophylaxis - child |
4,503 |
4,448 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
3,022 |
2,990 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,431 |
2,391 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,651 |
4,048 |
$77K |
| D1206 |
Topical application of fluoride varnish |
5,406 |
5,340 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,234 |
3,190 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
595 |
347 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,848 |
4,737 |
$56K |
| D1351 |
Sealant - per tooth |
1,956 |
475 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
335 |
132 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,185 |
1,098 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
352 |
231 |
$26K |
| D0274 |
Bitewings - four radiographic images |
719 |
717 |
$22K |
| D1110 |
Prophylaxis - adult |
394 |
393 |
$20K |
| D0330 |
Panoramic radiographic image |
232 |
228 |
$5K |
| D1354 |
|
174 |
93 |
$2K |
| D9248 |
|
14 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
55 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$701.84 |
| D0270 |
|
39 |
39 |
$186.20 |
| D0603 |
|
10,460 |
10,324 |
$0.00 |